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Fecal Transplant: Microbial Restoration of the Inflamed Gut

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Ulcerative Colitis
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Posted 10/8/2013 2:18 PM (GMT 0)
This came out on Oct 3rd. I dont see that it was posted yet.

http://www.sciencedaily.com/releases/2013/10/131001105108.htm

 

Posted 10/8/2013 3:38 PM (GMT 0)
This is the study that was just published in AJG along with the editorial the Old Mike posted a link to.

The significant contribution of the study was fairly complete profile of the microbiome of the donor stoop, and of the patients, pre treatment, and every few weeks after.

We need to get numbers from the current Canadian trial. This is limited because it reports only 5 patients - but 5 very carefully studied patients.

Some of their findings regarding different stages of colonization, and some lack of colonization, will be very useful for future research.

The more or less failure of FMT in their study is not the final word, but it doe sraise a flag of caution, as the accompanying editorial pointed out.

Also, the ScienceDaily reporter and editor should be reprimanded for the title. While the idea was to investigate 'restoration", the result pretty much were "failure to restore".

Post Edited (DBwithUC) : 10/8/2013 9:41:02 AM (GMT-6)

Posted 10/8/2013 3:58 PM (GMT 0)
http://medienportal.univie.ac.at/presse/aktuelle-pressemeldungen/detailansicht/artikel/microbial-restoration-of-the-inflamed-gut/

"A positive clinical response was observed after 12 weeks in one patient whose microbiota had been effectively augmented by FMT. This augmentation was marked by successive colonization of donor-derived phylotypes including the anti-inflammatory and/or short-chain fatty acid–producing Faecalibacterium prausnitzii, Rosebura faecis, and Bacteroides ovatus."

One patient apparently responded very well.... Even if it was really 20% that would still be huge. All this stuff has to go to algorithms. Biome testing + genetic testing, if this -> do that, if that -> do this.

It's all incredibly bloody complicated. Maybe in 10 years there will be no more ulcerative colitis, or Crohn's just different states of biome/immune/mucus problems and depending on the problem there will be different solutions.

Even if "straight forward" fecal transplant only helps 20%... (and who know it was only 5 people), maybe then there is a more complicated protocol fecal transplant (trying to replace very specific strains) combined with antibiotic treatment that will help another 20%.

Then the other 60% will need different things.
Posted 10/8/2013 5:04 PM (GMT 0)
The research is moving forward, and even the cautious editorial author, underscored the importance of further study.

I think there is some danger in latching on to the number 20%. The 95% confidence interval around that would range from 2.7% to 69.1%. And, since 2 of 5 people got worse (40%), the 95% confidence interval for harm is 10% to 80%. BUT, You need more people and some control of co-variates (i.e., severity, smoking history ... etc) to have good ideas about % helped and % hurt.



study details said...
Two of the patients in this study had
ongoing and increasing elevation of their CRP compared with
the post-metronidazole baseline level, suggesting that they may
have become sicker aft er this treatment. In the follow-up phase,
the authors describe a “collapse” due to orthostasis and, separately,
an unexplained case of pancreatitis. These observations
reinforce that administering a large volume of bacteria foreign
to the recipient, especially in those with an impaired mucosal
integrity, may have unintended consequences.

I think people who suspect they may have undetected c.diff, or people with mild but prolonged symptoms, may want to try FT, provided they can put as many safeguards as possible in place. This describes me. I need to think about this. First I want to do a trial going off 5-asa, just to make sure my residual symptoms are not from the meds. Also, I might wait for some type of FT pill. (But if I was given the option to have some donor FM during my next scoping, I would likely say yes.)

On the other hand, I think anybody that is just enamored of "natural" or just hates "Big Pharma" should seek help from a psychologist before seeking FMT, because 1 in 5 helped and 2 in 5 harmed is not good odds.
Posted 10/8/2013 5:30 PM (GMT 0)
"I think there is some danger in latching on to the number 20%. The 95% confidence interval around that would range from 2.7% to 69.1%"

Absolutely. I didn't mean to latch onto that number. I really just wanted to point out that hypothetically if you had a treatment that helped 20% it would be huge... it's hard sometimes because we really want to see "the cure" 85% success rate or something.... so when you see 20% it seems dissapointing at first glance, when in reality if (over a very large trial) the 20% figure was accurate it would be a breakthrough.

"On the other hand, I think anybody that is just enamored of "natural" or just hates "Big Pharma" should seek help from a psychologist before seeking FMT, because 1 in 5 helped and 2 in 5 harmed is not good odds."

Good point. I think those who have an agenda like this hurt the rest of us. Like I've said I'm convinced there's a different answer for different people. Real breakthroughs could be in stratification. If people start wanting a treatment based on an agenda that could be a problem.
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